...to not know how to cope with DH's anxiety?

[ActivelyAnxious]

My DH suffers from very bad anxiety. It's 'fixated' on different things over the years but now it manifests as near-constant anxiety about the end of the world. He constantly worries about war (particularly nuclear war), global warming, etc. Any news headline he glimpses that talks about global unrest - especially posturing from Russia - can set him off, but it can also just enter his mind at any time.

At various points over the years DH has seen a hypnotherapist and is currently trying talking therapy. A GP once prescriped anti-depressants (citalopram) but he was reluctant to take them because they would most likely increase his symptoms during the first few weeks.

Recently it feels as if the anxiety is near-constant. He is constantly talking about how much it invades his life and how he cannot stop thinking about it. We can be having a totally normal day and then he suddenly draws in on himself and I know he's having the anxiety.

I feel like it really impinges on our ability to have a happy life and I feel on edge all the time in case something out of my control (a headline on a paper stand, a friend bringing something up in conversation) sends him into a spiral. I don't know what to do to help.

I know IABU to feel frustrated about this -- but do any Mumsnetters have any suggestions at all for how I might help?!

There are better meds for anxiety than citalopram. Get him to go back to the GP after researching, yourself, what he needs.

YANBU to feel frustrated but he can only help himself. It's awful to live with.

encourage him to go back to the gp and ask for escitalopram. it has a slightly different pharmacology and has fewer side effects. More expensive see!

Then maybe seek out a cbt therapist as this helped me a great deal.

I worry about similar things and it has made me very ill over the years.

Should of said different GP - doling out citalopram for everyone and everything is just lazy.

I take Escitalopram and it is brilliant. DH is on Sertraline for his anxiety and it has really made a difference.

Do you think GPs would react well to me going along with him and advocating for him? He is really bad at speaking up for himself at the doctors - I just know he'd come out and say he'd been given citalopram anyway and hadn't felt able to ask for anything different!

Thanks so much for the tips r.e. different medications. I think when he's feeling so bad already the prospect of it getting worse is hard for him to handle.

My DP is in a medical job and often comes with me to advocate for me in appointments. I think that would be helpful for you and your DH.

Any GP worth his/her salts will be fine with an advocate. My sister has come with me, and me for her.

I take quetiapine for crippling anxiety and it is the only way I can have any standard of living. GP might not be able to prescribe it though - have you thought about a referral to a psychiatrist?

JJXM How would you get a referral - through the GP?

DH was referred by the Occupational Health folk at his work to a local counselling service, but I'm not sure if they're psychiatrists IYSWIM.

Go and advocate for him at your GP's, OP.

My DH has suffered from chronic anxiety almost all his adult life. For a while anti-depressants helped a bit until he suffered a breakdown due to bullying at work. After a number of false starts he has finally got a good psychiatrist who has got him well (he'll never be completely anxiety free but he's able to work and function normally most of the time).

I don't think there is such a thing as a magic bullet in terms of drugs unfortunately. DH doesn't do well with the most anti-ds and quetiapine mentioned by a PP made him so ill that he was hospitalised for a month.

DH found a support group environment helpful, CBT not very, but if your DH has a "fixation" type anxiety about "end-times" scenarios then CBT might be more helpful (my Dh's anxiety is much more generalised).

OP it sounds very tough for you both.

I had anxiety for years, and found CBT very helpful indeed. Counselling not at all, hypnotherapy useless, anti-d's quite good - I went down almost every route .

I know it sounds crap, but meditation, healthy diet and exercise also helped a bit (when I wasn't too anxious to go out the house that is).

Do you get any support - it must be exhausting to live with.

Archduke

We both do a fair bit of exercise. I should definitely urge my DH to do meditation.

He says that a problem is that when he isn't feeling anxious he finds it very hard to think about it, so it's hard for him to get into the habit of doing 'anti-anxiety' things when he isn't in that moment feeling bad.

I don't really get any support. I feel badly for DH because he has supported me through mental health problems of my own but I feel so bad at dealing with this! I find it very hard to deal with him when he starts 'spiralling' - I can sometimes get a bit angry and upset, partly because I feel so powerless. I am trying to be better, though. But it sometimes feels like we're just having the same conversation over and over again.

Yanbu to be frustrated, it sounds like you're directing it at the anxiety rather than DH and you want to support him

It sounds like a good idea to go with him to the GP, so you can help him get his point across. CBT can be very helpful for anxiety.

It's such a horrible illness and I feel sorry for you both. How does it manifest itself that it bothers you? My DH is lucky I guess that I don't really talk about it as I feel nobody gets it when I do anyway. I try very hard not to let it take over although I admit I do get a bit low and moody more than most when it is bad and my insomnia is awful but he sleeps through it!

I also struggle with anti-ds as I hate the side effects (although the first day is always lovely!) and I feel like it is a band aid and years of cbt and talk therapy haven't helped much.

Does he exercise? When i did everyday it got much better. Need to get back on it tbh.

As a mental health professional I disagree with the comments above regarding citalpram not being a 'good' medication. It can be very good and it is the nice approved first line treatment- it doesn't work for everyone but should be tried before other meds. I certainly disagree with the above poster who recommended that you research meds and go back to the GP to ask for a different one- you have no way of knowing what will work or not work without trying it. Anti depressants are very effective for anxiety, please return to the GP to discuss this. There is a chance symptoms could get worked before the my improve but this will only be for a week or to, most people feel it is worth it.

Also discuss an iapt referral with your GP, especially if you DH is not keen on the meds option.

I'd agree re different meds. My dh gets on well with aripiprazole for anxiety. I would certainly read up on first line meds for anxiety.

He would sympathise with your dh about not wanting to think about it when it's not happening, however, you are left worrying yourself which isn't good.

My feeling would be that the boring stuff like limiting exposure to news, daily exercise of at least a couple of hours, limited caffeine and alcohol are all good starting points. None of those will do what a good drug will though.

Titsywoo

I find it very upsetting when he clearly isn't mentally 'present' if you see what I mean. I also find it distressing when we've been having what I think is a good day together and then he tells me he's been feeling anxious for hours - it makes me feel guilty for having enjoyed myself and as though I can never be sure of whether he's ever genuinely having fun around me.

We do both exercise usually but he's been quite physically unwell these past few weeks, so it's slipped for him, which may be one reason why this bout has been so bad. Something I've suggested he does is start keeping a diary of his anxiety so he can track how different things (exercise, seeing his counsellor, etc) impact the anxiety.

acquiescence

Thanks for your comments, that's really helpful.

annandale

DH doesn't go on FB or any news websites so exposure to news is limited as much as it can be - pretty much it's what he glimpses in the shop as he goes for a pint of milk. I also don't think avoiding the triggers is more of short term solution. On a selfish level I also find it surprisingly hard to be guarding my own own tongue against current affairs things that concern me or that I would like to chat about.

Cital0pram is more for clinical depression than anxiety OP. And it takes 3weeks to kick in like most anti d's. Get back to Dr and ask for something else as per other posters advised and also ask for Cognitive Behavioural Therapy - it deals with catastrophising (yes its a word) negative thoughts and anxiety and gives common sense strategies to cope with and lessen them. CBT for Dummies is pennies secondhand on Amazon too and explains it in layman's language with the exercises too. Its done me the world of good with my tendency to go into a tail spin of anxiety/ panic and turn minor stuff into catastrophy , when in fact its not. You dont end up anxiety free but you do end up knowing when you are not being logical and minimising and managing it.

Have a look at the books and tapes by Dr Claire Weeks. There is also a DVD of a former patient of her who suffered immense anxiety and worked through it. Dr Weeks died many years ago but her books are on eBay and Amazon. I think the tapes may only be on her website. Don't Panic and Why Worry are also good books by Sue Bretton. You may also get them from your library but if you buy them you have them to refer back to. You can help your DH by reading them too.

Just remembered - there's also an interactive website called Living Life to the Full.

OP

Most GPs will welcome someone coming to advocate for the patient, as long as your husband is agreeable to you coming to his appointment - although the GP will be keen to here from your husband first and foremost.

I would second what Acquiesence says- citalopram can help people with anxiety, it is not solely used for depression and is one of the first line (and not prescribed solely on basis of cost as a PP suggested). As with all medications, there is the risk of side-effects. It is certainly not the only medication that can be effective though, as other PPs have outlined.

The guidelines suggest other forms of treatment before trying medication, although I note you say your DH is currently receiving talking therapy and has had hypnotherapy in the past. I don't know how long he has been having talking therapy or exactly what form this takes (is it CBT?) but it can take some time to have an impact- depending on how long he has been having this treatment, you may need to give it more time.

I would suggest going back to your GP and encourage your DH to explain what has been happening, how he feels and the impact on his functioning etc and you can help as needed. Using this information your GP can decide whether they can manage your DH's condition in the first instance and refer on if no headway after a suitable period, or whether your DH needs to be referred to community psychiatric team for assessment and support.

I've actually found citalopram really helpful for OCD and General Anxiety Disorder so I wouldn;t necessarily write it off without giving it a proper try.
I also found CBT really effective.
These types of intrusive thoughts are quite symptomatic of OCD is it possible he is suffering from this rather than anxiety?

Gamerwidow makes a good point- does your DH have a formal diagnosis? If not, I would strongly suggest going to your GP and discuss this- it may be they can confidently manage things (depending on their own knowledge- some GP have a specialist interest in mental health, for example, others have good basic working knowledge but may prefer to refer to a psychiatrist for assessment). Getting the correct diagnosis is an important step to getting effective treatment (whether medication or therapy).

My DH definitely wants me to go with him. I've been hesitant in the past in case the GP doesn't like having someone else come in!

R.e. CBT - DH isn't hugely keen on this as an approach. I've had it in the past and have tried to share some of the techniques I found useful with him and he says he just doesn't find it helpful. But this may be due to me explaining poorly! I get the impression this is the main type of 'talking therapy' that the NHS tends to go for. Are there any other approaches in terms of counselling / talking therapy?

As for a diagnosis - I think the GP we saw before (we don't live in the same place anymore so would definitely be seeing another GP) just diagnosed it as anxiety, though I agree that there are some similarities with OCD. The problem is that our local (rural) GP practice a) doesn't list the specialities of individual doctors, so I don't know if they have any MH specialists, and b) has a bit of a reputation for not liking to make referrals. Which I suppose is exactly why I need to go as an advocate!

Hello all. Thanks again so much for all your advice. I just thought I'd post a quick update. DH saw the GP about three and a half weeks ago and she put him on 20mg of Citalopram. He was very lucky with side-effects - just felt a bit spacey for the first week or so but nothing worse. It has certainly reduced his anxiety a noticeable amount but he says he feels it still isn't enough. He's seeing the GP again next week and we're both hoping they'll increase the dose.

Does anyone who has taken citalopram have any insight into whether the doses 'work' that way - i.e. that if he's seen an improvement but not a complete one on 20mg, 30mg or 40mg should make him feel proportionally more ok?

At the moment the thing that is triggering him most regularly is the sound of the TV from our (very deaf) downstairs neighbour. I'm very much hoping for a time when our lives will no longer be a hostage to anxiety - e.g. tonight he is now sitting miserably in the kitchen because he can't stand the noise in our living room.